RECENT ADVANCES IN THE MANAGEMENT OF ASTHMA

The talks by Dr. T.U. Sukumaran, Prof. of Pediatrics, Medical College, Kottayam and Dr. K.M. Ramesh Nair, Consultant Pulmonologist, Lakeshore Hospital,
Ernakulam were fascinating, interesting and an academic feast to IMA Cochin. Dr. T.U. Sukumaran discussed vividly the management of asthma in children with the emphasis on “Preventors in Asthma”. Simple guidelines in the clinical diagnosis of Asthma in Children, the clarification of intermittent and persistent asthma, clarification according to the severity into four steps were illustrated very clearly. The selection of the medication, the appropriate inhalation device and monitoring the children on preventions and long term management of ashma in children was stressed. Dr. Sukumaran drove home the message that cortico steroids (inhaled) is
the drug of choice in persistent asthma of childhood. Early intervention with inhaled steroids after the diagnosis or initial onset of symptoms of Asthma results in better response to treatment as this can prevent uncontrolled inflammation and airways remodeling. The concern with the use of long term steroid inhalation on growth of children could be overcome by the optimal and proper use of spacer and mouth rinsing after inhalation which will lower the risk of systemic side effects.
The discussion on the use of newer classes of drugs in childhood asthma drew the attention of all. Mention was made about the latest preventor ciclesonide – onsite activated steroid for children above the age of 8 to 10 years. The other drugs discussed were : single – Isomer B – Agonists. Levalbuterol, Leukotriene Inhibitors
Monteluicast, Anti – IgEAntibody Omalizumab, Long Acting B2 – Agonists – Combination of Laba with Montelukast. Dr. K.M. Ramesh Nair presented revolutionary newer drugs in Asthma in detail revealing how innovative pharmacological and immuno modulatory approached type delineation of Immunological pathways in the pathogenesis of asthma have yielded diverse therapeutic targets, providing new agents in the revolutionary treatment of asthma. Dr. Ramesh
Nair‘s talk was equally fascinating as all were spell hound by the presentation, eager to have the wonder newer drugs in Asthma which are more effective and with minimum side effects than the present drugs available. The newer drugs discussed were : Ciclesonide – onsite activated steroid, Anti – IgE Antibody , Soluble cylokine receptors, Interleukin - 5 Antagonists, Phosphodecisterase 4 inhibitators, Leukotriene Inhibitors, Montelukast, Prolukast, Zafir Lukast, Methyl Xanthines,
Combination of long acting & agonists and leukotriene inhibitors. Drugs in the horizar for treatment of Asthma – Rasons – Respirable antisenoe oligonucleotides.
During the discussion time it was concluded that the successful in the mangement of Asthma, education of patient, parents and relatives about the nature of the disease, all aspects of the drugs used and the steps required to avoid acute exacerbations and triggers of asthma is mandatory and very essential.

Dr. Pratap Kini, President, IAP Cochin